Regular Research ArticlesSocial Emotion Recognition, Social Functioning, and Attempted Suicide in Late-Life Depression
Section snippets
OBJECTIVES
Suicide rates are the highest in old age in almost every country in the world. Yet, it is difficult to identify those at risk, since known risk factors, such as depression, pain, disability, or financial problems have limited predictive power.1, 2, 3 The role of deficits in cognitive abilities is a poorly understood part of the suicidal diathesis,4,5 especially in older adults.6 The failure to deal with social stressors may play a particularly important role in suicidal behavior, and indeed
METHODS
Ninety participants age 60 and older were recruited between June 2006 and October 2009: 24 depressed suicide attempters and 38 nonsuicidal depressed elders were recruited on an inpatient psychogeriatric unit and in a late-life depression clinic; 28 elders with no psychiatric history were recruited from University and community primary care practices. Depressed participants met criteria for major depressive disorder as determined by the Structured Clinical Interview of the Diagnostic and
STATISTICAL ANALYSES
Continuous measures were compared among the three groups using one-way analyses of variance (ANOVA); categorical data were compared with κ2 tests. All tests were two-sided. An analysis of covariance (ANCOVA) was conducted to compare the number of errors on the RME with age, sex, education, substance abuse, and DRS scores as covariates. Tukey Honestly Significant Difference (HSD) post-hoc tests were conducted when significant differences were detected among the groups. Within the attempter
Demographic and Clinical Characteristics
There were no statistical differences among the three groups in age, sex, race, marital status, level of education, MMSE, or EXIT scores (Table 1). There was no significant difference in sex distribution although we note that 61% of the elders with no psychiatric history were men versus 38% of attempters and 34% of nonsuicidal depressed participants. Attempters had significantly lower DRS scores than the two other groups. Levels of physical illness burden (CIRS-G scores) and intensity of
CONCLUSIONS
We identified a deficit in the recognition of complex social facial emotions in older suicide attempters compared to nonpsychiatric controls. However, this effect could not be disaggregated from reduced global cognition in suicide attempters. The performance of nonsuicidal depressed elders was intermediate between the two groups. There were several indicators of poor social functioning in suicide attempters: they reported a pattern of struggle against others, hostility in relationships, and a
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Szanto, Dombrovski, and Houck do not have any conflict of interest. Clark and Sahakian are affiliated to the Behavioral and Clinical Neuroscience Institute, which is supported by a consortium award from the Medical Research Council (UK) and the Wellcome Trust. Clark and Sahakian consult for the Cambridge Cognition. Mulsant currently receives research support from the US National Institute of Mental Health, the Canadian Institutes for Health Research, Bristol-Myers Squibb, and Wyeth. During the past 5 years, he has also received research support or honoraria from Astra-Zeneca, Eli Lilly, Forest Laboratories, GlaxoSmithKline, Janssen, Lundbeck, and Pfizer. He previously held stocks (all less than $10,000) of Akzo-Nobel, Alkermes, AstraZeneca, Biogen, Celsion, Elan, Eli Lilly, Forest, Orchestra Therapeutics, and Pfizer. Reynolds receives research support in the form of pharmaceutical supplies from Bristol-Myers Squibb, Pfizer, Eli Lilly, and Forest Laboratories.
The authors thank Professor Baron-Cohen of the Autism Research Centre, University of Cambridge, for providing the Reading the Mind in the Eyes Test.
This work was supported by a National Institute of Health K23 grant (MH070471) and R01 MH05436 and an American Foundation for Suicide Prevention Junior Investigator grant to K. Szanto and the P30 MH71944 and the UPMC Endowment in Geriatric Psychiatry for C. Reynolds.